Healthcare Provider Details

I. General information

NPI: 1346317823
Provider Name (Legal Business Name): RONIT HERZOG MD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 11/29/2006
Last Update Date: 02/28/2024
Certification Date: 02/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

60 FENWOOD RD
BOSTON MA
02115-6128
US

IV. Provider business mailing address

1 COLUMBUS PL APT S47B
NEW YORK NY
10019-8216
US

V. Phone/Fax

Practice location:
  • Phone: 617-732-9850
  • Fax:
Mailing address:
  • Phone: 917-669-1863
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code207K00000X
TaxonomyAllergy & Immunology Physician
License Number209192
License Number StateMA
# 2
Primary TaxonomyN
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number232880
License Number StateNY
# 3
Primary TaxonomyY
Taxonomy Code2080P0201X
TaxonomyPediatric Allergy/Immunology Physician
License Number209192
License Number StateMA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: